Provider Demographics
NPI:1427451491
Name:MIDTOWNPARK1 PRIMROSE ESSENTIALS HEALTH GROUP
Entity type:Organization
Organization Name:MIDTOWNPARK1 PRIMROSE ESSENTIALS HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-743-9322
Mailing Address - Street 1:32740 RAPHAEL RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1763
Mailing Address - Country:US
Mailing Address - Phone:989-743-9322
Mailing Address - Fax:
Practice Address - Street 1:30300 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-2149
Practice Address - Country:US
Practice Address - Phone:989-743-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty